In­dus­try Groups Aim to Speed Prior Au­tho­riza­tion Process

Health Data Management - - NEWSLINE - —F.B.

NA­TIONAL ELEC­TRONIC STAN­dards are ex­pected to play a key role in an in­dus­try­wide ef­fort to stream­line the process of com­mu­ni­cat­ing prior au­tho­riza­tions for treat­ment.

Groups rep­re­sent­ing hos­pi­tals, physi­cians, med­i­cal groups, health in­sur­ers and phar­ma­cists have an­nounced a joint ef­fort to fa­cil­i­tate the of­ten lengthy in­surance ap­proval process called prior au­tho­riza­tion— also known as pre-ap­provals—that slow de­liv­ery of treat­ment to pa­tients.

The col­lab­o­ra­tion in­cludes the Amer­i­can Hos­pi­tal As­so­ci­a­tion, Amer­ica’s Health In­surance Plans, Amer­i­can Med­i­cal As­so­ci­a­tion, Amer­i­can Phar­ma­cists As­so­ci­a­tion, Blue Cross Blue Shield As­so­ci­a­tion and Med­i­cal Group Man­age­ment As­so­ci­a­tion.

Fa­cil­i­tat­ing the prior au­tho­riza­tion process also is ex­pected to pro­vide ben­e­fits to the health­care in­dus­try, par­tic­i­pants in the ini­tia­tive say—it could re­duce ad­min­is­tra­tive bur­dens for health­care pro­fes­sion­als, hos­pi­tals and health in­sur­ers.

Typ­i­cally, if a treat­ment or pre­scrip­tion re­quires prior au­tho­riza­tion, it must be ap­proved by a health in­surer be­fore it’s ad­min­is­tered. These ap­provals can be bur­den­some for all par­ties be­cause the pro­cesses vary and of­ten are repet­i­tive. Stream­lin­ing can re­duce the num­ber of steps and time de­lays.

The groups have signed a con­sen­sus state­ment, pledg­ing to work to­gether on a va­ri­ety of ini­tia­tives. In par­tic­u­lar, they are com­mit­ting to ac­cel­er­at­ing in­dus­try adop­tion of na­tional elec­tronic stan­dards for prior au­tho­riza­tion and im­prov­ing trans­parency of for­mu­lary in­for­ma­tion and cov­er­age re­stric­tions at the point of care.

The or­ga­ni­za­tions say they will seek to im­prove com­mu­ni­ca­tion be­tween health in­sur­ers, health­care pro­fes­sion­als and pa­tients to min­i­mize de­lays in care and en­sure clar­ity on prior au­tho­riza­tion re­quire­ments, ra­tio­nale and changes.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.